運用Swanson關懷理論照顧一位老化產生無望感患者之護理經驗

Nursing Experience Utilizing Swanson’s Caring Theory to Address Hopelessness in an Aging Patient

本文旨在描述一位因老化導致身體衰弱、活動功能退化而長期臥床，進而衍生出諸多併發症之個案，護理期間自2020年11月17日至12月11日，藉由身體檢查、傾聽、觀察、會談及病歷查閱等方式收集資料，運用Swanson關懷理論為架構，確立個案主要健康問題有：(一)組織完整性受損；(二)呼吸道清除功能失效；(三)尿路感染；(四)無望感。在照護期間藉由跨領域團隊合作提供整體性及個別性照護，強化主要照顧者照護知識及能力，鼓勵個案參與復健計畫，減少改善現存問題並預防潛在問題，運用主動關懷及同理心等技巧與個案及主要照顧者建立信任的護病關係，鼓勵說出內心感受，協助家庭成員之間的溝通，減輕照護者的照護負荷及壓力，提升照護品質。藉此護理經驗分享，提供臨床照護參考，建議照護老年患者可進行以病人為中心的健康整合式評估，提供社會資源評估及照護者支持系統兩面向，希望能早期發現老年人功能衰退問題，早期介入以延緩衰弱與失能。

This study aimed to describe the care provided to a patient who was bedridden for a long time because of physical weakness and deteriorated mobility due to aging, resulting in various complications. The nursing period spanned from November 17 to December 12, 2020. Data were collected through physical examinations, listening, observation, interviews, and medical record reviews. Using Swanson’s caring theory as a framework, the main health problems identified were as follows: (1) impaired tissue integrity, (2) impaired respiratory clearance function, (3) urinary tract infection, and (4) feelings of hopelessness. Throughout the care period, cross-disciplinary teamwork was employed to deliver holistic and individualized care. Efforts were made to enhance caregivers’knowledge and abilities, involve patients in rehabilitation programs, address existing problems, and prevent potential issues through proactive care and empathetic communication with patients and primary caregivers. Building trustful nurse–patient relationships, encouraging the expression of feelings, and supporting family members in communication were also integral aspects of the care provided. The aim was to ensure that the patients and their families received comprehensive care addressing physical, psychological, and social needs. By improving individual care and the quality of life of family members, the care period could progress smoothly, leading to the patient’s eventual return home and receipt of appropriate and complete care.